Provider Demographics
NPI:1669735262
Name:MILLER, COURTNEY (LCSW)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 N INTERLUDE WAY
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-8026
Mailing Address - Country:US
Mailing Address - Phone:559-679-7910
Mailing Address - Fax:
Practice Address - Street 1:2350 W SHAW AVE
Practice Address - Street 2:STE 116
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3412
Practice Address - Country:US
Practice Address - Phone:559-573-4194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA808051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical